Graves’ disease (a common cause of ‘Hyperthyroidism’)

Graves’ disease (Graves’) is actually a syndrome—or collection of conditions/manifestations—that most often consists of hyperthyroidism (over-active thyroid), but can also consist of a goiter (an enlarged thyroid), protrusion of the eyes (exophthalmos; pronounced ek-sof-thal-muhs) and occasionally a rash on the skin overlying the shins, referred to as dermopathy and localized leg swelling, called myxedema (pronounced mik’-si-dee-muh).

Hyperthyroidism is the most common feature of Graves’ disease, affecting nearly all patients.  It happens because the body develops antibodies that link up and over-stimulate a key component of thyroid hormone release (theh TSH receptor) The over-stimulation causes increased levels of thyroid hormone, as well as thyroid growth (usually causing a diffusely enlarged goiter).

Graves’ runs in families and is much more common in women than men.

RISK FACTORS: Possible precipitating and predisposing factors include:

–    genetic susceptibility (family history)

–      infections

–       stress

–       smoking

–       pregnancy

–       excessive iodine.

SYMPTOMS OF GRAVES’ DISEASE

-Sudden weight loss, even when your appetite and diet remain normal or even increase

-Rapid heartbeat (tachycardia) — commonly more than 100 beats a minute — irregular heartbeat (arrhythmia) or pounding of your heart (palpitations)

-Increased appetite

-Nervousness, anxiety and irritability

-Tremor — usually a fine trembling in your hands and fingers

-Sweating

-Changes in menstrual patterns

-Increased sensitivity to heat

-Changes in bowel patterns, especially more frequent bowel movements

-An enlarged thyroid gland (goiter), which may appear as a swelling at the base of your neck

-Fatigue, muscle weakness

-Difficulty sleeping

** Older adults are more likely to have either no signs or symptoms or subtle ones, such as an increased heart rate, heat intolerance and a tendency to become tired during ordinary activities. Medications called beta blockers, which are used to treat high blood pressure and other conditions, can mask many of the signs of hyperthyroidism.

TREATMENT

The treatment for the hyperthyroidism depends on symptoms and includes, medications like methimazole that block the antibody from overstimulating the thyroid gland, radioiodine therapy which essentially kills the hyperactive cells of the thyroid and surgery to remove part or all of the thyroid gland.

** With radioiodine treatment, the radioiodine can cause eye problems.  The initial increase in thyroid antibody concentrations after radioiodine therapy may explain why, in these patients, Graves’ eye problems may appear for the first time or may transiently worsen afterwards.